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Pharmacology Exam 2 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

BP =

A

CO x HR

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2
Q

Angiotensin II

A

Vasoconstricts and controls aldosterone release

= Increased blood volume and BP

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3
Q

Aldosterone

A

Causes kidneys to reabsorb sodium and inhibit fluid loss

= Increased blood volume and BP

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4
Q

Risks associated with HTN

A

Heart attack, heart failure, stroke, and kidney disease.

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5
Q

Until age 50, ___ is a more potent RF.

A

DBP

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6
Q

After age 50, ___ is a more potent RF.

A

SBP

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7
Q

Coarctation of the aorta

A

= Narrowing of the aorta.
When this occurs, the heart must pump harder to force blood through the narrow part of the aorta.
= Cause of HTN

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8
Q

Obstructive uropathy

A

Structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction (obstructive nephropathy).
= Cause of HTN

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9
Q

Pheochromocytoma

A

A rare, catecholamine-secreting tumor that may precipitate life-threatening hypertension.
= Cause of HTN

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10
Q

Primary aldosteronism

A

One of the more common causes of secondaryHTN

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11
Q

Normal BP (JNC 7)

A

SBP <120, and DBP < 80.

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12
Q

Prehypertension (JNC 7)

A

SBP 120 – 139 or DBP 80 – 89.

Recheck in 1 year.

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13
Q

Stage 1 HTN (JNC 7)

A

SBP 140 – 159 or DBP 90 – 99.

Confirm within 2 months.

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14
Q

Stage 2 HTN (JNC 7)

A

SBP ≥ 160 or DBP ≥ 100.

Evaluate or refer within 1 month. If > 180/110 evaluate and treat immediately or within 1 week.

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15
Q

Thiazide/Thiazide-like Diuretic

A

MOA:
Excrete Na
Leads to PVR reduction
Contraindications:
Anuria
Renal decompensation
Hypersensitivity to thiazides or sulfonamides
Adverse events:
Potential for negative impact on dislipidemia, glucose control
Monitor for Na+, K+, Mg+ depletion
Elevated calcium, uric acid, glucose, cholesterol

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16
Q

Beta-adrenergic antagonists (BB)

A

MOA:
β-1 receptors (heart & kidneys) – stimulating effect
β-2 receptors (lungs, liver, pancreas, arteriolar smooth muscle) – relaxing effect
Cardioselective bind specifically to β-1 receptors
Non-cardioselective bind to β-1 and β-2 receptors
Adverse events:
Use with caution in untreated heart block
May cause bronchospasm
May worsen insulin resistance
May mask hypoglycemia
With discontinuation: taper over 10-14 days

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17
Q

Alpha-beta adrenergic antagonist

A 
Carvedilol, labetalol
MOA: Block adrenergic β-1, β-2, alpha-1 receptor sites, blunt catecholamine response
Adverse events:
Use with caution in untreated heart block
May cause bronchospasm
May worsen insulin resistance
Less insulin resistance compared to BB
Taper over 10-14 days
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18
Q

Carvedilol (Coreg)

A

Potent antihypertensive agent with a dual mechanism of action.
At relatively low concentrations it is a competitive beta-antagonist and a vasodilator, whereas at higher concentrations it is also a calcium channel antagonist. Potent competitive antagonist of beta 1- and beta 2-adrenoceptors. Carvedilol is also a potent alpha 1-adrenoceptor antagonist, which accounts for most of the vasodilating response produced by the compound.

19
Q

Angiotensin-converting enzyme inhibitors (ACEI)

A 
"-pril" suffix
Mechanism of Action:
Inhibit Angiotensin Converting Enzyme
Decreases conversion of Ang I to Ang II (potent vasoconstrictor).
Contraindications:
Renal artery stenosis
History of angioedema
Pregnancy category D
Adverse Events:
Chronic dry cough, rashes, dizziness
Hyperkalemia
Angioedema, laryngeal edema
20
Q

Angiotensin II Receptor Blockers (ARB)

A 
"-sartan" suffix (eg. losartan, telmisartan)
MOA:
Selectively bind to Ang II receptors
Block vasoconstricting and aldosterone-secreting effects of Ang II
Contraindications:
Pregnancy category D
Angioedema
Impaired kidney or liver function
Adverse Events:
Cough, fatigue, diarrhea, respiratory tract infections
Hyperkalemia
Angioedema
21
Q

Renin Inhibitors

A 
Aliskiren (Tekturna)
Mechanism of Action:
Blocks conversion of Angiotensinogin to Ang I
Contraindications:
Pregnancy
Adverse Events:
Diarrhea
Angioedema
22
Q

DHP Calcium channel blockers

A

The most smooth muscle selective class of CCBs are the dihydropyridines. Used to treat hypertension.
“-ipine” suffix (eg. amlodipine, felodipine)
MOA:
Inhibit movement of calcium across cell membranes
Decrease contractility of myocardial and smooth muscle
Contraindications:
Heart failure
Adverse Events:
Headache, flushing, palpitations, peripheral edema

23
Q

NonDHP Calcium channel blockers

A 
Non-dihydropyridines, comprise the other two classes of CCBs.
Diltiazem, verapamil
Mechanism of Action:
Slows conduction at AV node
Slows heart rate
Contraindications:
Heart failure
Adverse Events:
Peripheral edema 
Bradycardia
AV block
Constipation
24
Q

Aldosterone antagonist

A 
Spironolactone, Eplerenone
MOA:
Block effects of aldosterone
Better regulation of Na+ &amp; water 
Better maintenance of intravascular volume
Adverse events: 
Hyperkalemia
Gynecomastia with prolonged use
Caution in renal impairment
25
Q

Centrally-acting agents

A 
Clonidine, methyldopa
MOA:
Works at brain BP control center
Adverse events:
Sedation risk
Abrupt withdrawal of clonidine can lead to rebound HTN
26
Q

JNC 8 recommendation for >60 y/o

A

SBP <150, DBP <90

27
Q

JNC 8 recommendation for <60 y/o, >18 with CKD, >18 with DM

A

SBP <140, DBP <90

28
Q

JNC 8 for Non-Black patients

A 
Thiazide
ACEI
ARB
or CCB
alone or in combination
29
Q

JNC 8 for Black patients

A

Thiazide
or CCB
alone or in combination

30
Q

JNC 8 for CKD patients (all races)

A

ACEI
or ARB
alone or with other drugs

31
Q

B-blocker, aldosterone antagonist, or others

A

Are second line per JNC 8

32
Q

Tx stable angina

A

Beta-blocker

Long-acting calcium channel blocker (2nd choice)

33
Q

Tx acute coronary syndrome

A

Beta-blocker AND ACE inhibitor

34
Q

Tx post MI

A

Beta-blocker AND ACE inhibitor

35
Q

Tx HF

A

ACEI

End stage: loop diuretic

36
Q

Tx Cerebrovascular Disease

A

ACEI AND thiazide diuretic

37
Q

Tx BPH

A

Alpha-1 receptor blockers “-zocin”

38
Q

Peds Prehypertension

A

BP 90th-95th % or BP >120/90

39
Q

Peds Stage I HTN

A

95th-99th percentile

40
Q

Peds Stage II HTN

A

99th percentile plus 5 mm Hg

41
Q

Chronic HTN and Pregnancy

A

Chronic HTN: diagnosed before pregnancy or before 20wks
Methyldopa: drug of choice for chronic HTN diagnosed in pregnancy
Beta blockers: safe in 2nd & 3rd trimester
Contraindicated: ACE, ARB, DRI

42
Q

Preeclampsia

A

HTN with proteinuria after 20 wks gestation
Delivery > 48hrs away: methyldopa, labetalol, CCB
Imminent delivery: Parenteral hydralazine, labetalol

43
Q

Gestational HTN

A

HTN without proteinuria after 20 wks

Careful monitoring for preeclampsia

44
Q

Transient HTN

A

BP normal by 12 wks postpartum

Pharmacology Exam 2 (11 decks)

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